Metrics

A CAQH study, conducted by IBM Global Business Services, assessed results achieved by six CORE-certified health plans that represent 33 million covered lives (Aetna, AultCare, BlueCross BlueShield of North Carolina, BlueCross BlueShield of Tennessee, Health Net, and WellPoint affiliated health plans), as well as leading provider groups and vendors using the CORE Phase I rules. The study analyzed data from the three-month period prior to health plan certification and one year later. Study results showed that CORE certification dramatically cuts administrative costs and accelerates HIT adoption by both health plans and providers.

Based on results from the study, an industry-wide implementation of the CORE Rules could yield $3 billion of savings in three years.

Key findings include:

Electronic insurance eligibility verifications took approximately seven minutes less than telephone verifications, saving providers $2.60 per verification. There are more than 1 billion claims verified for eligibility each year in the U.S.

Providers working with CORE-certified health plans saw a 24% increase of patients verified prior to a visit, significantly reducing administrative burden at the point of care.

Health plans that became CORE-certified had a payback in less than 12 months. For example, by switching from telephone to real-time electronic claims verification, the average annual reduction in administrative costs can be more than $2.5 million per plan.

Contact CAQH CORE

CAQH CORE Participant Calendar

User ID (case sensitive)

Password (case sensitive)

How the Affordable Care Act Influenced CORE Certification

CAQH Deputy Director Gwen Lohse explains the important role that the Affordable Care Act played in impacting CAQH CORE Certification and the usage of CAQH CORE operating rules in this HealthPayerIntelligence article.